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Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Heel pain – plantar fasciitis is inflammatory thickening of the plantar fascia, usually at the origin from the calcaneum and is a common cause of heel pain. The diagnosis is usually clinical but in refractory cases ultrasound can be used to confirm the diagnosis, exclude other conditions such as plantar fibroma or fibromatosis or to guide steroid injection. Achilles tendon pathology is another common cause of heel pain located posteriorly. Chronic tendinopathy is very common as the Achilles tendon also carries a major load during ambulation and is subject to acute inflammation or tears sometimes related to relatively trivial trauma. Ultrasound and MRI can establish the diagnosis of tendinopathy and assess the presence of tears. Partial or complete rupture can be assessed. Dynamic ultrasound can also assess the tendon gap in complete rupture.
Alterations in Achilles tendon stress and strain across a range of running velocities
Published in Journal of Sports Sciences, 2023
Bryce Ertman, Melissa Klaeser, Lucas Voie, Naghmeh Gheidi, C. Nathan Vannatta, Drew Rutherford, Thomas W. Kernozek
Running is a popular mode of exercise due to its accessibility and positive influence on various health factors. However, the incidence of running-related injuries to the lower extremity is high, with an estimated incidence of 37% (Dempster et al., 2021). Females showed a higher mean incidence of injury than males (Dempster et al., 2021; van Gent et al., 2007). Of these overuse injuries, Achilles tendon (AT) injury accounts for 5–18% of these injuries, affecting as many as 1 in every 20 runners (Lagas et al., 2020; Lopes et al., 2012; van Gent et al., 2007). Achilles tendinopathy is believed to occur because of the high forces and repetitive loading associated with running (Cook et al., 2016; A. Scott et al., 2015). This high repetitive loading is believed to cause microtrauma to the AT collagen fibres. With adequate rest, the body undergoes collagen synthesis to repair the affected tissue. However, if adequate rest is not provided before continued loading, the tendon is unable to undergo reconstruction and continues to endure microtraumas, resulting in tendon degeneration and disorganization of tissue that may become more susceptible to injury (Magnusson et al., 2010).
Does radiofrequency application improve function and reduce pain in patients with insertional Achilles tendinopathy? A retrospective study with a minimum 2-year follow-up
Published in Research in Sports Medicine, 2023
Yujie Song, Xiao’ao Xue, Yinghui Hua
Achilles tendinopathy causes persistent tendon pain, which leads to compromised function and participation in work and recreation activities (Scott et al., 2020). It has been reported to affect 9% of recreational runners and up to 5% of professional athletes end their careers due to the debilitating effects of this condition (Lysholm & Wiklander, 1987). It could be furtherly subdivided into insertional and midportion tendinopathy based on their distinct aetiology, injury mechanism, and affected location (Li et al., 2017). Insertional Achilles tendinopathy (IAT) may also present with retrocalcaneal bursitis, Haglund’s deformity and calcific deposits within the substance of the Achilles tendon proximal to its calcaneal insertion (Touzell, 2020). Currently, non-surgical treatment is usually the first choice for Achilles tendinopathy, but no univocal evidence exists regarding the best management (Aicale et al., 2020; de Vos et al., 2021). Various non-operative treatment options are available for IAT, including heel lifts (Wilson et al., 2018), eccentric or stretching exercises (Murphy et al., 2019; Porter et al., 2002), shockwave therapy (Liao et al., 2018), and injection therapy (Boesen et al., 2019; Madhi et al., 2020). For cases refractory to non-operative treatment, surgery can be beneficial. This involves an open or arthroscopic debridement of the Achilles tendon, plantaris resections, excision of the Haglund’s deformity and removal of the inflamed retrocalcaneal bursa (Masci et al., 2021; Touzell, 2020). However, surgical procedures might not always be effective as the poor relationships between changes in structure and changes in patients’ symptoms (de Vos et al., 2012).
One fifth of patients with Achilles tendinopathy have symptoms after 10 years: A prospective cohort study
Published in Journal of Sports Sciences, 2022
Iris F. Lagas, Johannes L. Tol, Adam Weir, Suzan de Jonge, Peter L.J. van Veldhoven, Sita M.A. Bierma-Zeinstra, Jan A.N. Verhaar, Robert-Jan de Vos
We often refer to long-standing Achilles tendinopathy (AT) as being chronic, yet we know little about the actual chronicity of symptoms on the long term. Symptoms normally improve quickly during the first year of treatment, but recovery is usually only partial (De Jonge et al., 2010, 2011; Silbernagel et al., 2007). After 1 year there seems to be a relative stagnation in improvement (Paavola et al., 2000; Silbernagel et al., 2011; Van der Plas et al., 2012). It seems that a subgroup of patients experience persisting symptoms.